16622 Granulomatous reaction to microneedling

Abstract

A 49-year-old Caucasian female with a history of type two diabetes mellitus and essential hypertension presented for outpatient evaluation for pruritic tender erythematous scaling plaques on the face that arose abruptly 7 days after a microneedling session to the corresponding areas. The microneedling was performed in a medical spa and a hyaluronic acid, glycerin, zinc, and copper containing serum was applied before the treatment session. The patient had minimal relief of symptoms with BID application of triamcinolone acetonide 0.1% cream for 7 weeks that was prescribed by per primary care provider. The patient denied any systemic symptoms. A 4-mm punch biopsy was performed and the patient was initiated on minocycline 100 mg bid orally, clobetasol 0.05% cream bid × 7 days followed by triamcinolone acetonide 0.1% cream bid × 7 days, then iodoquinol 1%-hydrocortisone 1% cream bid × 7 days, then tacrolimus 0.1% ointment bid. The punch biopsy revealed a granulomatous dermatitis with no foreign body observed with polarized light. Systemic and cutaneous sarcoidosis and infectious etiologies were ruled out before a diagnosis of granulomatous reaction to microneedling was reached. Traditionally, granulomatous hypersensitivity reactions have followed inoculation of metallic elements, silica, zirconium or collagen. Granulomatous hypersensitivity reactions secondary to dermal inoculation of antigenic cosmeceutical products during microneedling is likely severely underreported. The majority of products applied before microneedling sessions are not FDA approved for intradermal injection. This case hopes to bring awareness to adverse reactions to microneedling.